MEMORANDUM

DATE:             June 8, 1999

TO:                   ALL MEDICAL ASSISTANCE MANUAL HOLDERS

THROUGH:    Jim Nordlund, Director

                          Division of Public Assistance

FROM:             Bob Labbe, Director

                          Division of Medical Assistance

RE:                   Medical Assistance Manual Change #22

Medical Assistance Eligibility Manual Change #22 implements a number of policy changes and clarifications, including

• CSED cooperation;

• development of income;

• new poverty guidelines;

• deprivation (eliminates 100-hour rule and deprivation by incapacity);

• incorporating certain AFDC Aid to Families with Dependent Children policies; and

• new SLMB eligibility categories.

The most significant policy change is the long awaited elimination of the 100-hour rule.  Last fall, federal regulations were revised to give each state authority to define for themselves what constitutes an unemployed parent when determining deprivation for Family Medicaid.  Our new definition is income based with no limitation on the number of hours worked.  It also allows us to eliminate the need for making PWE and deprivation by incapacity determinations.

Here is a summary of the most substantial changes in Manual Change #22:

NonFinancial Eligibility -- 5015

This section is reformatted to remove reference to old sections, change the page numbering, and remove section 5015.9.

Cooperation with Child Support Enforcement -- 5016

The substance of former Section 5015.9 and AFDC Aid to Families with Dependent Children Manual Section 327 are incorporated into this new section.  It follows the simplified pattern of the CSED cooperation section of the Temporary Assistance manual, but does have new and unique Medicaid policy.  Like always, an adult who fails to cooperate without good cause is ineligible for Medicaid.  However, for Medicaid and Denali KidCare, the needs of the ineligible adult continue to be included when determining household size.  This is to insure that when a parent fails to cooperate the child is not made ineligible because the household size and corresponding need standard are reduced.  This change is the result of new federal guidance on this issue.

Development of Income -- 5018

This new section replaces the policy in AFDC Aid to Families with Dependent Children Manual Section 332, with some significant differences concerning Unemployment Insurance Benefits ( UIB Unemployment Insurance Benefit ).  Now, unless the individual is specifically exempt, all individuals who appear eligible for UIB Unemployment Insurance Benefit are required to apply for and pursue UIB Unemployment Insurance Benefit .  This reverses existing Family Medicaid policy.  Considering the fact that AFDC Aid to Families with Dependent Children linked Medicaid required only the PWE in a two-parent household to apply for and pursue UIB Unemployment Insurance Benefit , this new requirement appears to contradict the prohibition on Family Medicaid being more restrictive than AFDC Aid to Families with Dependent Children .  However, delinking Medicaid from AFDC Aid to Families with Dependent Children brings into play another long-standing federal Medicaid regulation (42 CFR 435.608).  This regulation requires all applicants and recipients to pursue all other benefits that may be available to them and specifically includes UIB Unemployment Insurance Benefit as one of those benefits.  In addition, the old AFDC Aid to Families with Dependent Children policy of requiring the PWE to pursue UIB Unemployment Insurance Benefit is no longer valid because there is no PWE determination under the new deprivation by unemployment standards noted below.

In addition, this section provides for a number of exemptions from applying for UIB Unemployment Insurance Benefit , which are similar (but not identical) to AFDC Aid to Families with Dependent Children exemptions from JOBS participation and ATAP Alaska Temporary Assistance Program exemptions from work activities.  The medical/incapacity related exemption is simplified.

Federal Poverty Guidelines for Alaska -- 5032

This section is updated to reflect the 1999 Federal Poverty Guidelines for Alaska.  Because the federal poverty guidelines were published late this year, the new income standards based on the FPG Federal Poverty Guidelines were not implemented in Alaska until May 1, 1999.

AFDC Aid to Families with Dependent Children /Family Medicaid Conversion Guide -- 5105

The Conversion Guide is amended to provide that AFDC Aid to Families with Dependent Children Manual Section 325 (Deprivation) and Section 332 (Development of Income) in their entirety no longer apply to Family Medicaid.  The policies in those sections are completely replaced by Medical Assistance Manual Sections 5018, 5125, 5126, 5217, and 5128.  The reference to AFDC Aid to Families with Dependent Children Manual Section 310 is amended to allow that the needs of an ineligible alien parent are included when determining household size.  This is to insure that a child is not made ineligible because the household size and corresponding need standard are reduced.

Deprivation -- 5125

This section summarizes the three causes for deprivation recognized by Family Medicaid and explains why deprivation by incapacitated parent is no longer used.  Consequently, none of the policy currently found in AFDC Aid to Families with Dependent Children Manual Section 325-3 is carried over to the Medical Assistance Eligibility Manual.

Deprivation by Unemployment -- 5127

This section redefines deprivation by unemployment in a way that eliminates the “100 hour rule” and the need to determine which parent is the principal wage earner (PWE).  Determining deprivation by unemployment is now an income test only.  Under the new definition, if the combined family income is below the need standard for a family of that size, the family is considered meaningfully unemployed and deprivation is considered to exist.  This section also provides for pregnant women in the third trimester.

Deprivation by Continued Absence -- 5128

This new section incorporates all of the relevant portions of AFDC Aid to Families with Dependent Children Manual Section 325-2 on deprivation by continued absence.  This is generally the same policy, except that the 50% rule is eliminated.

Medicare Premium Categories -- 5590 through 5595

Two new Medicare premium related eligibility categories are added and the section is reorganized.  The new eligibility categories, SLMB Plus and SLMB Subsidy, were implemented with the January 20, 1999 broadcast.  The “capped entitlement” nature of these new categories require special case processing.

MANUAL CHANGE #22 INSTRUCTIONS

Remove old pages and replace with new pages as indicated below: